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Adult 1 Unit 2 > GI3 > Flashcards

GI3 Flashcards

1
Q

best practices for paracentesis

A
  1. explain proceedure
  2. vitals w weight
  3. void prior to proceedure
  4. elevate head of bed
  5. monitor vital
  6. measure drainage accurately record, describe, lable and send to lab
  7. dress site, bedrest per protocol
  8. weigh pt and record difference
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2
Q

cirrhosis meds

A

INDERAL- beta blocker to help prevent bleeding ( reduces heart rate and hepatic venous pressure gradient)
Vasopressin and Sandostatin will reduce blood flow through vasoconstriction to decrease portal pressure
Sandostatin suppresses secretion of gastrin, serotonin and intestinal peptides which helps decrease GI blood flow

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3
Q

ascites causes

A

Increased hydrostatic pressure from portal hypertension
More plasma proteins are in the peritoneal fluid rather the vascular system. The liver does not produce albumin as well. This results in low protein in the circulatory system
The patient will have hypovolemia as well as third spacing in the peritoneal cavity along with edema
Massive ascites put pressure on the kidney which triggers the renin-angioretensin system. This causes sodium and water retentions which increases swelling

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4
Q

nutrition therapy for a pt w liver disease

A

low sodium, vitamins, high carb mederate fat, low protein

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5
Q

lab value abnormalities that increase risk of bleeding w end stage liver disease

A

elevated ast, alt, bili, PT, INR

decreased total protein, albumin

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6
Q

clay colored stool

A

inability of failing liver to excrete bilirubin

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7
Q

jaundice causes

A

intrahepatic obstruction from edema to the bile channels, elevated serum total bilirubin

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8
Q

hepatitis vaccines

A

A and B

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9
Q

Hep A risk factors

A 
Spread most often by fecal oral route
Flu like infection that may go unrecognized
Oral anal or contaminated food or water
Shellfish or food handlers
Incubation period 15-20 days
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10
Q

Hep B risk factors

A

Blood and fluid transmission
Sex, needles, transfusions (now screened after 1992), Hemodialysis
Immunosuppressed more likely to develop
Incubation period 25-180 days
Many people with Hep B do not exhibit sx. If they do they might have jaundice, fever, joint pain, anorexia, N/V, RUQ pain, dark urine with light stool
Most adults who get Hepatitis B are able to clear it from their bodies and develop immunity
Small amount people do not develop immunity but become carriers

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11
Q

Hep C risk factors

A

Spread blood to blood
Blood or organ transplants received before 1992
Illicit drug use (highest incidence)
Unsanitary tattoos
Sharing intranasal cocaine equipment
Do not share razors, toothbrushes or pierced earrings
Average incubation period 7 weeks
May be asymptomatic for months or years after initial exposure
Acute infection not common
Most people DO NOT clear the virus and chronic infection develops

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12
Q

common signs of elevated ammonia levels (hepatic encephalopathy) stage 1

A

subtle, may not be recognized immediately

  • personality, behavior, emotional, thinking, concentration
  • fatigue, slurred/slowed speech, sleep disturbances
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13
Q

common signs of elevated ammonia levels (hepatic encephalopathy) stage 2

A

continuing mental changes

  • confusion, disorientation to time, place, person
  • asterixis (hand flapping)
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14
Q

common signs of elevated ammonia levels (hepatic encephalopathy) stage 3

A

progressive deteriorentation

  • marked mental confusion
  • stuporous, drowsy but arousable
  • abnormal ECG, muscle twitching, hyperreflexia
  • asterixis
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15
Q

common signs of elevated ammonia levels (hepatic encephalopathy) stage 4

A

unresponsive, obtunded, no asterixis

  • positive babinski
  • muscle rigidity
  • fetor hepaticus-musty sweet liver breath
  • seizures/death
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16
Q

lactulose

A

promotes excretion of ammonia in stool. Draws fluid into colon and reduces the absorption of ammonia into colon. Hypokalemia and dehydration may occur with all of the loose stools

17
Q

propranolol

A

lower portal pressure and inhibit renin secretion with ascites

18
Q

spironolactone

A

diuretic for ascites, conserves potassium

19
Q

hepatic encephalopathy diet changes

A

moderate protein and fat and simple carbs

20
Q

cholecystits risk facotrs

A

fat, fair, forty, female, fertile

21
Q

cholecystits diagnostic tests

A

ultrasound, abdominal xray, HIDA scan, ERCP, MRCP

22
Q

diet changes after chole

A

avoid high fat foods

23
Q

pathophysiology of acute pancreatitis

Stage 1 lipolysis

A

Hallmark of pancreatitis is Lipolysis causing fatty acids to be released which combine with calcium. The calcium drops quickly. The parathyroid glands can’t keep up to raise the calcium so hypocalcemia develops.

24
Q

pathophysiology of acute pancreatitis

Stage 2 proteolysis

A

Proteolysis is the breakdown of proteins. May lead to thrombosis and gangrene

25
Q

pathophysiology of acute pancreatitis

Stage 3 necrosis of blood vessels

A

Elastase causes blood vessels and ducts to breakdown
Kallikrein ( another enzyme) triggers release of other chemicals that cause vasodilation and increase vascular permeability

26
Q

pathophysiology of acute pancreatitis

Stage 4 inflammatory stage

A

Inflammatory stage – WBC gather around area of hemorrhage and necrosis. If infection severe calcification and fibrosis occur. Abscess may be walled off and become a pseudocyst

27
Q

complications of acute pancreatitis

A

jaundice, hemorrhage, acute kidney failure, paralytic ileus

  • hypovolemic shock, pleural effusion, ARDS, atelectasis
  • pneumonia, MSOF, DIC, DM2
28
Q

etiology of acute pancreatitis

A

biliary tract disease, trauma (surgical, diagnostic tests, external)
-tumors, cysts, metabolic disorders, ulcers, familial pancreatitis, cystic fibrosis, drug toxicities, alcoholism, smoking

29
Q

chronic pancreatitis interventions

A

pain management
PERT- pancreatic enzymen replacement therapy prevents malnutrition, malabsorption, and excessive weight loss-don’t give w H2 blockers, don’t mix w protein, monitor uric acid levels
-need 4000-6000 calories a day
-high carb, high protein, low fat

30
Q

pancreatic abcess

A

fatal if untreated, high recurrance rate, high fever

31
Q

pancreatic pseudocyst

A

no epithelial lining, form on or around pancreas, palpated, epigastric pain radiating to back, may spontaneously resolve or rupture

32
Q

pancreatic cancer complications

A

venous thromboembolism, late detection, highly metastatic

33
Q

post op care w open radiac pancreaticoduodenectomy-whipple

A

maintain fluid and electrolyte balance, significant blood loss (hypovolemia), decreased BP w increased HR, decrease urine output, pitting edema, monitor glucose, NPO w NG

Adult 1 Unit 2 (20 decks)

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